Provider Demographics
NPI:1346615648
Name:FIORENZA, JOHN PETER (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:FIORENZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2354
Mailing Address - Country:US
Mailing Address - Phone:708-636-0565
Mailing Address - Fax:
Practice Address - Street 1:5425 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2354
Practice Address - Country:US
Practice Address - Phone:708-636-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist